Association between intrarenal venous flow from Doppler ultrasonography and acute kidney injury in patients with sepsis in critical care: a prospective, exploratory observational study

Critical Care

Research

Masayoshi Yamamoto¹  Noriko Iida²  Yoshihiro Seo³  Norimichi Uenishi⁴  Teruhiko Terasawa⁵  Kenichiro Fujii⁵  Mitsunaga Iwata⁵  Junichi Izawa⁶  Izumi Nakayama⁷ 

[1] Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan;Clinical Laboratory, University of Tsukuba Hospital, Tsukuba, Japan;Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan;Department of Emergency and General Internal Medicine, Fujita Health University Hospital, Toyoake, Japan;Department of Emergency and General Internal Medicine, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukakecho, 470-1192, Toyoake, Aichi, Japan;Division of Intensive Care Medicine, Department of Internal Medicine, Okinawa Prefectural Chubu Hospital, Uruma, Japan;Department of Preventive Services, Kyoto University School of Public Health, Kyoto, Japan;Division of Intensive Care Medicine, Department of Internal Medicine, Okinawa Prefectural Chubu Hospital, Uruma, Japan;Department of Public Health, School of Medicine, Yokohama City University, Yokohama, Japan;Department of Health Data Science, Graduate School of Data Science, Yokohama City University, Yokohama, Japan;

关键词: Ultrasonography;    Renal congestion;    Intrarenal venous flow;    Acute kidney injury;    Sepsis;   

DOI  :  10.1186/s13054-023-04557-9

 received in 2023-03-30, accepted in 2023-06-28,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundIntrarenal venous flow (IRVF) patterns assessed using Doppler renal ultrasonography are real-time bedside visualizations of renal vein hemodynamics. Although this technique has the potential to detect renal congestion during sepsis resuscitation, there have been few studies on this method. We aimed to examine the relationship between IRVF patterns, clinical parameters, and outcomes in critically ill adult patients with sepsis. We hypothesized that discontinuous IRVF was associated with elevated central venous pressure (CVP) and subsequent acute kidney injury (AKI) or death.MethodsWe conducted a prospective observational study in two tertiary-care hospitals, enrolling adult patients with sepsis who stayed in the intensive care unit for at least 24 h, had central venous catheters placed, and received invasive mechanical ventilation. Renal ultrasonography was performed at a single time point at the bedside after sepsis resuscitation, and IRVF patterns (discontinuous vs. continuous) were confirmed by a blinded assessor. The primary outcome was CVP obtained at the time of renal ultrasonography. We also repeatedly assessed a composite of Kidney Disease Improving Global Outcomes of Stage 3 AKI or death over the course of a week as a secondary outcome. The association of IRVF patterns with CVP was examined using Student's t-test (primary analysis) and that with composite outcomes was assessed using a generalized estimating equation analysis, to account for intra-individual correlations. A sample size of 32 was set in order to detect a 5-mmHg difference in CVP between IRVF patterns.ResultsOf the 38 patients who met the eligibility criteria, 22 (57.9%) showed discontinuous IRVF patterns that suggested blunted renal venous flow. IRVF patterns were not associated with CVP (discontinuous flow group: mean 9.24 cm H2O [standard deviation: 3.19], continuous flow group: 10.65 cm H2O [standard deviation: 2.53], p = 0.154). By contrast, the composite outcome incidence was significantly higher in the discontinuous IRVF pattern group (odds ratio: 9.67; 95% confidence interval: 2.13–44.03, p = 0.003).ConclusionsIRVF patterns were not associated with CVP but were associated with subsequent AKI in critically ill adult patients with sepsis. IRVF may be useful for capturing renal congestion at the bedside that is related to clinical patient outcomes.Graphical abstract

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

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